Brain Stimulation: Chapter 13. Deep brain stimulation for essential tremor

Brain Stimulation: Chapter 13. Deep brain stimulation for essential tremor
ISBN-10
0128080191
ISBN-13
9780128080191
Series
Brain Stimulation
Category
Medical
Pages
784
Language
English
Published
2013-11-11
Publisher
Elsevier Inc. Chapters
Authors
Rajesh Pahwa, Kelly E. Lyons, Jules M. Nazzaro

Description

Essential tremor is the most common tremor disorder and is characterized by a postural and kinetic tremor. Most commonly, the disease involves the upper extremities, although other body parts may be affected. Essential tremor is seen most often in adults and may markedly limit abilities to perform daily activities. Medications often fail to control the tremor adequately. In the past, ventral intermediate nucleus of the thalamus (VIM) thalamotomy was the surgery of choice for medication-resistant patients with disabling tremor. With technological advances, deep brain stimulation (DBS) to the VIM has replaced thalamotomy as the operation of choice for patients with essential tremor, given the heightened risk of permanent neurological deficits associated with ablative surgery. Multiple studies have demonstrated that unilateral VIM DBS has significant short- and long-term benefits for targeted tremor. Unilateral VIM DBS may also improve head and voice tremor, although most commonly bilateral stimulation is required for adequate control. However, bilateral thalamic stimulation is associated with a higher incidence of neurological deficits, particularly speech and gait problems. Investigations of DBS of other brain target areas for essential tremor, such as the posterior subthalamic area and the subthalamic nucleus, are ongoing.

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